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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629128
Report Date: 08/02/2021
Date Signed: 08/02/2021 04:47:02 PM

Document Has Been Signed on 08/02/2021 04:47 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MOORE, CHERYL FAMILY CHILD CAREFACILITY NUMBER:
376629128
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/02/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Cheryl Moore TIME COMPLETED:
09:40 AM
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On 08/02/21 at 9:10 a.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted an announced Pre-Licensing inspection. Upon visit, LPA met with applicant, Cheryl Moore and proceeded to tour the home. The purpose of today's inspection is to ensure the pool fencing meets regulations under California Code Regulation 101238. Facility plans to operate from Monday through Friday from 6:00 a.m. to 6:00  p.m.

LPA observed the fencing to surround the pool with no access to the inside of the pool area from the windows of the house. The pool is fenced with a five feet high fence with openings on fence no wider than four inches, and in no way obstruct a complete and clear view of the pool from the outside. In addition, the pool fence has two gates that are self-closing, self-latching and swing away from the pool, per LPA observation. There is one pool entrance that is located on the north side of the home and another entrance located near the front of the backyard. The applicant will utilize the backyard for outdoor activities. LPA informed applicant, the pool gates shall not be locked, as it may be necessary for an adult to enter the pool area without having to find a key or remember a combination. Applicant submitted verification of the measles vaccination at time of inspection.

An exit interview was conducted with the applicant. The following was discussed and provided: LIC809 and Appeal Rights. After final file review, a small family childcare license shall be issued and mailed to the applicant. LPA informed applicant, once the license is received to post in a prominent place in the home. 
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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